It is the most important and most common voiding disorder of childhood. If the child cannot wake up and urinate on the bed due to the need to empty himself when the functional capacity of the urinary bladder is full during sleep, it is called “enuresis”.
Enuresis is one of the most common problems in childhood. It is an important problem that affects the child, family and environment. It reduces the child’s self-confidence, can cause embarrassment and psychological problems.
Enuresis is defined as urinary incontinence that recurs voluntarily or involuntarily (at least 2 times a week) on the bed or clothes, day or night, after the age at which urinary control is expected (5 years). Depending on the onset and course of enuresis, it can be primary or secondary. Sleep urination persists in some children from birth without any intervening periods of dryness, this is called the primary type (primary enuresis); in others, after a period of toilet training (at least 6 months), sleep urination started suddenly at any age. This is called the secondary type (secondary enuresis).
Enuresis can be nocturnal or diurnal. Urinating at night while sleeping is called nocturnal enuresis, and voiding while awake during the day is called diurnal enuresis. If there is no other complaint in children who urinate only during sleep, day or night, it is called single symptom voiding during sleep (monosymptomatic enuresis nocturna). For nocturnal enuresis, expressions such as bed-wetting or bed-wetting during sleep should not be used as they are accusatory definitions, instead the term “voiding while sleeping” should be preferred.
First of all, a doctor should be consulted and it should be investigated whether there is a disease such as organic causes, congenital disorders or urinary tract inflammation. If the investigation does not find any disease, the following may be the reason for the child’s bedwetting:
Premature or over-stressed toilet training is the most common cause of enuresis.
It shows the child’s reaction to the pressured toilet training of an extremely clean, meticulous, organized mother.
No toilet training can also lead to enuresis. The mother’s overprotection, the child’s long-term dependence on herself, and her subconscious desire make the child infantile.
The birth of a new sibling may cause the child to wet the bed by emulating his sibling in order to regain the attention.
Anxiety created by life events in the family, such as death, separation, incompatibility, illness and school failure, may reflect on children’s behavior in the form of enuresis.
Approximately 15% of five-year-old children have Enuresis nocturna. Rates of 5%-15% are reported from various countries. It is more common in boys. The frequency of enuresis nocturna, which can also heal on its own, decreases with age and continues at a rate of 1% in adulthood. In addition, the rate of comorbid conditions in enuresis is quite high.
The attitude of the parents is very important in the child’s bedwetting and incontinence. The family may feel anger and shame, punish the child, compare him with his siblings. On the contrary, some families unknowingly support enuresis, such as tying a diaper to the child, kissing and loving him while changing his diaper. It should be known that both attitudes are harmful, that is, neither punishment nor rewarding with loving behavior is correct.
First of all, the child needs support. Scolding, embarrassing, or punishing is not right.
Getting up to the toilet at night can solve the problem. Especially the child should be awakened 1.5 hours after sleep. Because bed-wetting occurs most often during this period of sleep. The child is awakened and urinated. There is not much difference in terms of education between urinating in a semi-asleep state and doing it while sleeping in the bed.
There are different treatment methods. These are behavior modification (motivation therapy, conditioning-alarm therapy, bladder retention education), hypnotherapy and drug therapy (anticholinergics, tricyclic antidepressants, vasopressin) methods.
Hypnotherapy and/or psychotherapy can be applied as a choice in terms of high success rates, safety in terms of side effects and ease of application, as it provides a high rate of complete and sustained dryness in children with enuresis. Detection and elimination of the main cause, as well as the absence of other possible symptoms as a secondary gain due to the strengthening of the ego, and the development of the ability to cope with other possible psychosomatic conditions make these methods attractive.
